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General NPI Number Information
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NPI Number | 1689745291
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Entity Type | Organization
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Legal Business Name | CEDAR CREST MANOR INC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 1700 NW FORT SILL BLVD
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City | LAWTON
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State | OK
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Zip | 73507-4064
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Country | US
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Telephone | 580-355-1616
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Fax | 580-355-2814
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Provider Business Mailing Address
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Address Line | 1700 NW FORT SILL BLVD
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City | LAWTON
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State | OK
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Zip | 73507-4064
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Country | US
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Telephone | 580-355-1616
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Fax | 580-355-2814
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | MRS. TARRI ALDRIDGE
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Credential |
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Telephone | 580-355-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH1602-1602
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License Number State | OK
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